W. Va. Code R. § 114-73-3

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-73-3 - Eligibility of Small Employers

3.1. A small employer is eligible to purchase a health benefit plan subject to the following conditions:

a. On or before December 11, 2004, a small employer is eligible to purchase a health benefit plan if the small employer has not provided health care coverage for its employees at any time during a period beginning December 11, 2003 through the date on which the health benefit plan is purchased.

b. After December 11, 2004, a small employer is eligible to purchase a health benefit plan if the small employer has not provided health care coverage for its employees for twelve consecutive months prior to obtaining the health benefit plan.

c. The small employer will pay at least fifty percent (50%) of individual employee coverage for its eligible employees.

d. Every small employer seeking to obtain a health benefit plan must furnish to the carrier an Affidavit, in a form acceptable to the Commissioner, from which the carrier may verify the eligibility of the small employer. A copy of the affidavit must be filed with the Commissioner. The provisions contained in the Affidavit shall include but not be limited to the following:

1. As applicable, a representation that the small employer has never provided health care coverage for its employees or the date on which the small employer last provided health care coverage for its employees.

2. For an employer that was in existence for all of the preceding calendar year, the average number of employees that were employed during the preceding calendar year and the number of employees employed on the first day of the small employer's group health plan year.

3. A representation that the majority of eligible employees are employed in West Virginia or, if no state contains a majority of eligible employees, that the primary business location of the small employer is in West Virginia.

4. A representation that the small employer is actively engaged in business in the state of West Virginia.

5. A representation that the small employer was not formed for the purpose of securing health benefits coverage under W. Va. Code § 33-16D-16.

6. A disclosure of the true and accurate name(s) of the business entity, including but not limited to DBAs and trade names.

7. As applicable, a disclosure of the following changes to the small employer if the changes occurred after January 1, 2004:

A. Any business name changes;

B. Amendments to or restatement of the articles of incorporation;

C. Reincorporations;

D. Mergers with other businesses;

E. Dissolutions;

F. Withdrawals;

G. Reinstatements;

H. Conversions; and

I. Any other changes relating to the structure, ownership or governance of the small employer.

Copies of documents associated with the disclosures listed in subparagraphs A through I of this paragraph must be provided to the carrier by attachment to the Affidavit.

W. Va. Code R. § 114-73-3